Propensity score analysis demonstrates no long term survival benefit from contemporary endovascular aneurysm repair compared to open in Aotearoa New Zealand.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Publishing Asia Country of Publication: Australia NLM ID: 101086634 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1445-2197 (Electronic) Linking ISSN: 14451433 NLM ISO Abbreviation: ANZ J Surg Subsets: MEDLINE
    • Publication Information:
      Publication: Carlton, Victoria, Australia : Wiley-Blackwell Publishing Asia
      Original Publication: Carlton, Victoria, Australia : Blackwell Science Asia on behalf of the Royal Australasian College of Surgeons, c2001-
    • Subject Terms:
      Aortic Aneurysm, Abdominal*/surgery ; Aortic Aneurysm, Abdominal*/mortality ; Endovascular Aneurysm Repair* ; Propensity Score*; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; New Zealand/epidemiology ; Retrospective Studies ; Survival Rate ; Time Factors ; Treatment Outcome
    • Abstract:
      Background: Current guidelines for AAA management are based on landmark trials comparing EVAR and open aneurysm repair (OAR) conducted more than 20 years ago. Important advancements have been made in peri-operative care but the impact of EVAR and OAR on long-term patient survival has not been well reported using contemporary data. The objective of this study was to compare the short and long-term outcomes of OAR and EVAR in the recent era.
      Methods: This retrospective observational study included all patients undergoing intact AAA repair in NZ from 1st of January 2011 until 31st of December 2019. Data was collected from national administrative and clinical vascular databases and matched using unique identifiers. Time-to-event survival analyses was conducted using cox proportional hazard models to adjust for confounders and propensity score matching were used.
      Results: Two thousand two hundred and ninety-seven patients had an intact AAA repair with a median (IQR) age of 75 (69-80) years; 494 (21.2%) patients were females and 1206 (53%) underwent EVAR. The 30-day mortality for OAR and EVAR was 4.8% and 1.2%. The median (IQR) follow up was 5.2 (2.3-9.2) years. After propensity matching for co-variates, the study cohort consisted of 835 patients in each matched group. Patients undergoing EVAR had a higher overall mortality (HR 1.48 (95% CI: 1.26-1.74) after adjusting for confounders compared to OAR.
      Conclusion: Analysis of survival following EVAR and OAR in the current era demonstrates that patients that underwent EVAR had a lower 30-day mortality. However, in the long-term after adjusting for confounders OAR had a better overall survival.
      (© 2023 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)
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    • Contributed Indexing:
      Keywords: abdominal aortic aneurysm; contemporary practice; endovascular aneurysm repair; open aneurysm repair; propensity score matching
    • Publication Date:
      Date Created: 20231222 Date Completed: 20240521 Latest Revision: 20241112
    • Publication Date:
      20241113
    • Accession Number:
      10.1111/ans.18815
    • Accession Number:
      38131414